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Alaska rates for HCPCS 31030

Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,783.95 / $10,175.36 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,382.27 / $2,907.75 / $3,470.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.54 / $1,663.54 / $2,042.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.29 / $2,907.75 / $4,070.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.28 / $3,267.60 / $4,154.14
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,092.50 / $2,625.00 / $3,874.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.29 / $2,907.75 / $4,070.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.40 / $2,416.25 / $3,958.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.53 / $1,649.64 / $3,902.46